PrEP for Women

What Is PrEP?

PrEP stands for Pre-Exposure Prophylaxis. It means
taking medicine before being exposed to something to prevent yourself
from getting a disease or condition. We use several kinds of medicine this
way.

One example is taking anti-malaria medication when we travel to areas where
we might be bitten by mosquitoes that carry malaria. When the medicine is in a
person's body before getting a mosquito bite, that person is much less likely
to get malaria when she or he is bitten.

For women, another example is taking birth control pills (contraceptives). When contraceptives are already in a
woman's body when she is exposed to semen during sex, her chances of getting
pregnant are greatly reduced.

When we talk about PrEP in connection to HIV and women, we are referring to
the idea of HIV-negative women taking HIV drugs to reduce their risk of
becoming infected with HIV if they are exposed to it. Some people use the term
'topical PrEP' to describe the use of microbicide gels. However, in this
article when we talk about PrEP, we are referring only to 'oral PrEP,' or HIV
drugs taken by mouth as prevention.

How Does PrEP Prevent the Spread of HIV?

Here is how PrEP works:

When cells are infected with HIV, they become little factories that make
thousands of new viruses each day

HIV drugs work by blocking HIV from making copies of itself

If an HIV-negative woman already has HIV drugs in her bloodstream when she
is exposed to HIV during unprotected sex, for example, the medicine might
be able to keep the HIV from making enough copies of itself to "take hold" and
prevent her from becoming infected

Truvada Approved for Use as PrEP

Based on the findings of studies mentioned below, in July 2012, the US Food
and Drug Administration (FDA) approved the daily use of Truvada (emtricitabine
plus tenofovir) as PrEP for sexually active adults at risk of HIV infection.
Truvada is a drug often used as part of combination drug treatment for HIV.
This is the first time the FDA has approved any drugs for the prevention of
HIV.

Has PrEP Been Shown to Be Effective?

Three recent clinical trials have shown that taking Truvada as oral PrEP (one pill by
mouth daily) can help prevent HIV. These studies were conducted among men who
have sex with men (MSM) and transwomen (people who were born male and identify
as women) in the US and Latin America, and among heterosexual women and men in
several African countries. The effectiveness for PrEP varied from 44 percent to
73 percent additional protection against HIV infection in these three studies
(known as the iPrex, TDF2, and Partners studies).

A fourth study, however, called FemPrEP, was stopped early because it did
not seem to help in preventing HIV transmission. FemPrEP was testing the
effectiveness of oral daily Truvada in Kenyan, Tanzanian, and South African
women at high risk for HIV.

Why Are the Research Findings Unclear?

For any drug or other HIV prevention tool to work, it has to be used; and
research tells us that it has to be used correctly and consistently. This is
true for condoms and is proving true for PrEP as well. In the four studies
mentioned above, the key element in PrEP's success was "adherence," which means taking the drug when and how it is prescribed. In
the FemPreEP study, there were low levels of adherence; only about 30 percent
of the women in the group receiving the drug took it regularly. Additionally,
many women in the FemPrEP study did not consider themselves at risk for HIV.
The other three studies had much higher rates of adherence. In all studies,
people who took Truvada daily as prescribed were significantly less likely to
get infected with HIV when exposed during sex.

We do not yet fully understand all of the reasons why people -- especially
women -- have low levels of adherence to oral PrEP. This makes it very important
to do more research looking at what issues might affect women's interest in or
ability to take a drug for HIV prevention. We may know more about how Truvada
is effective for women when the results of a study of over 5,000 HIV-negative
women in South Africa, Uganda, and Zimbabwe become available in early 2013
(known as the VOICE study).

It is also important for women to know about and take part in the future
research that will look at the unanswered questions about Truvada as PrEP. For
more information about understanding, finding, and participating in research
studies, see The Well Project's
Clinical Trials info sheet.

CDC and WHO Guidelines for PrEP Use

The Centers for Disease Control and Prevention (CDC), which had already
provided guidelines for PrEP use among men who have sex with men (MSM),
released guidelines in August 2012 for Truvada's use as PrEP by heterosexually
active adults. Specifically, the CDC recommends that PrEP be available for
heterosexual HIV-negative women and men at high risk for sexually-transmitted
HIV infection (for example, those with a partner living with HIV (HIV+)).

It further recommends that PrEP be taken daily as prescribed to maximize its
effectiveness and that it be used in combination with other HIV prevention
strategies (i.e., condoms). PrEP is not intended to be used alone to prevent
the spread of HIV, because it is not 100% effective. It is also important that
all those being prescribed Truvada as PrEP test negative for HIV before
starting the medication and get tested regularly while taking it.

Lastly, the CDC recommends that HIV-negative women who are pregnant or who
are trying to become pregnant talk with their health care providers about the
risks and benefits of taking Truvada for PrEP. While the information we have to
date does not show negative effects among infants exposed to Truvada during
pregnancy, this information comes from HIV+ women taking Truvada. There is very
little data on HIV-negative women using Truvada during pregnancy.

The World Health Organization (WHO) has also issued guidance for
heterosexually active women and men. It recommends that, in countries where HIV
is spread in couples in which one partner is living with HIV, both Viread
(tenofovir) and Truvada be considered as possible additional prevention choices
for the HIV-negative partner.

This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

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